New food allergy and intolerance guidelines should help clear confusion

After two years of effort by doctors, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases just released its Guidelines for the Diagnosis and Management of Food Allergy in the United States. Developed primarily for health care professionals (a lay-language version for patients and families is due early 2011), the report is designed to help any doctor with diagnosis and management of food allergy and related conditions, including food intolerance.

Food allergy news seems to be everywhere these days. But it’s an understatement to say there’s been a lot of confusion over the definition of and difference between food allergy (such as a peanut allergy), food intolerance (such as gluten sensitivity), and autoimmune disease such as celiac. Even a lot of doctors often don’t know the difference.

Finally, some clarity and guidelines now exist. On Monday, after two years of effort by doctors, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases released its Guidelines for the Diagnosis and Management of Food Allergy in the United States. Developed primarily for health care professionals (a lay-language version for patients and families is due early 2011), the report is designed to help any doctor with diagnosis and management of food allergy and related conditions, including food intolerance.

"I am so thankful for the guidelines and the people who did this work," says Lucy Gibney, MD, president of Dr. Lucy's allergen-free snacks and mother of a child with severe food allergies. "This collaborative, comprehensive, and clear effort will make a complex topic much easier to handle. What I like the most is that they are essentially providing do’s and don’ts for food allergy." (See Key Food-Allergy Recommendations, below.)

Highlights of the report include:

Definitions of food allergy and related disorders like food intolerance

Recommendations on how to diagnose and what tests to use

How to manage non-life-threatening “allergic” reactions

How to diagnose and manage potentially life-threatening and other acute reactions

Anyone who’s taken their child to several different doctors -- family docs, emergency room physicians, gastroenterologists, dermatologists, pulmonary specialists -- without getting an answer to persistent symptoms knows how the lack of consistent information can prevent a clear diagnosis (until recently, the average time to diagnose celiac disease was 11 years), let alone effective treatment. My own college-age son was sick for 18 months and saw several doctors before a nutritionist finally recommended a food-elimination diet, thus identifying his gluten intolerance. Hopefully, this document will go a long way toward helping medical professionals to help their patients with food-related conditions.

Key food-allergy recommendations for physicians

According to Lucy Gibney, MD, the new NIAID report covers these do's and don'ts for doctors:

1. Don’t rely solely on blood testing for diagnosis. It is best to also include a physician-supervised food challenge. (guideline 7, guideline 11)

2. If you are including blood testing in diagnosis or management, do use certain types of blood tests (allergen-specific serum IgE) and not others. (guideline 7, guideline 6)

3. Do rely on the avoidance of allergens to prevent reactions. (guideline 19) Don’t pre-medicate with antihistamines to "avoid" reaction, and don’t use immunotherapy for treatment until it is fully researched and ready for regular use in the medical setting. (guideline 26, guideline 28)

4. Do begin introduction of solid food for infants between 4 and 6 months of age. (guideline 40)

5. Do use epinephrine to treat severe reactions. Do treat early and seek immediate medical care. Your health provider can provide information on signs and symptoms of severe reaction. (guideline 42)

6. Do avoid eating foods with precautionary labeling, such as “this product may contain trace amounts of allergen.” (guideline 24)